1/
Case #2 fr Michelle!
75M with prostate ca s/p rad, HTN
4d back pain, confusion per wife
Likes to garden and spend time outdoors
Noted incidentally to have scattered rash on trunks/extremities
Labs:
WBC 15k, H&H 13.3/38.9
Na 128
Cr 0.6
AST/ALT 50s
Case #2 fr Michelle!
75M with prostate ca s/p rad, HTN
4d back pain, confusion per wife
Likes to garden and spend time outdoors
Noted incidentally to have scattered rash on trunks/extremities
Labs:
WBC 15k, H&H 13.3/38.9
Na 128
Cr 0.6
AST/ALT 50s
2/
Dx'd with early disseminated Lyme.
Has evidence of 1st degree AV block on EKG
Has had some mild mental status fluctuations with confusion per wife but otherwise cognitively intact. No meningismus on exam.
Na 128 --> 125
How would you treat? #IDTwitter #MedTwitter #IDMedEd
Dx'd with early disseminated Lyme.
Has evidence of 1st degree AV block on EKG
Has had some mild mental status fluctuations with confusion per wife but otherwise cognitively intact. No meningismus on exam.
Na 128 --> 125
How would you treat? #IDTwitter #MedTwitter #IDMedEd
3/
We recently discussed early disseminated Lyme and its manifestations!
We recently discussed early disseminated Lyme and its manifestations!
4/
A discussion point here is when to select PO vs IV therapy. Most recent recommendations note its reasonable to use oral therapy with certain cases of both CNS lyme and cardiac Lyme, but often favor IV therapy in hospitalized pts.
pubmed.ncbi.nlm.nih.gov/27115378/
A discussion point here is when to select PO vs IV therapy. Most recent recommendations note its reasonable to use oral therapy with certain cases of both CNS lyme and cardiac Lyme, but often favor IV therapy in hospitalized pts.
pubmed.ncbi.nlm.nih.gov/27115378/
5/
Here is a recent examination from Europe of oral doxycycline vs IV Ceftriaxone in treatment of Lyme neuroborreliosis - oral doxy w/similar results to IV ceftriaxone
pubmed.ncbi.nlm.nih.gov/32133487/
Here is a recent examination from Europe of oral doxycycline vs IV Ceftriaxone in treatment of Lyme neuroborreliosis - oral doxy w/similar results to IV ceftriaxone
pubmed.ncbi.nlm.nih.gov/32133487/
6/
Ultimately this pt was treated with PO doxycycline with improvement.
One other quick note, SIADH has been noted with neuroborreliosis:
pubmed.ncbi.nlm.nih.gov/30297492/
pubmed.ncbi.nlm.nih.gov/29296248/
Ultimately this pt was treated with PO doxycycline with improvement.
One other quick note, SIADH has been noted with neuroborreliosis:
pubmed.ncbi.nlm.nih.gov/30297492/
pubmed.ncbi.nlm.nih.gov/29296248/
